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Current Hepatology Reports

, Volume 17, Issue 2, pp 121–129 | Cite as

Treatment of DAA-Experienced Patients with Chronic Hepatitis C

  • Maria A. Corcorran
  • John D. Scott
Hepatitis C (A Aronsohn and H Vargas, Section Editors)
  • 50 Downloads
Part of the following topical collections:
  1. Topical Collection on Hepatitis C

Abstract

Purpose of Review

The development of interferon-free direct-acting antiviral (DAA) regimens for the treatment of chronic hepatitis C (HCV) has significantly improved rates of sustained virologic response (SVR), shortened treatment duration, and improved drug tolerability across genotypes. While SVR rates now exceed 95% among treatment-naïve patients, there are a growing number of patients who have experienced DAA treatment failure and represent an emerging clinical challenge. This review discusses recent data on sofosbuvir/velpatasvir/voxilaprevir, sofosbuvir/velpatasvir, and glecaprevir/pibrentasvir for the treatment of DAA-experienced patients, as well as updated American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidelines.

Recent Findings

Data from phase 3 randomized clinical trials show that retreatment of DAA failures is successful in > 90% of patients using the above three regimens. The preferred retreatment regimen is dependent on HCV genotype, possible drug-drug interactions, prior treatment experience, and host factors such as the presence of cirrhosis and renal failure. Sofosbuvir/velpatasvir is a reasonable option for DAA-experienced genotype 1b and genotype 2 patients, but has been shown to be inferior to sofosbuvir/velpatasvir/voxilaprevir in genotype 1a and genotype 3 patients. Glecaprevir/pibrentasvir is a very attractive option for treatment of DAA-experienced genotype 1 and 2 patients, but it is not approved for treatment of DAA-experienced patients with genotype 3, and data is lacking to support its use in DAA treatment-experienced patients with genotypes 4–6.

Summary

The potency and high barrier to resistance of newer DAA regimens create an opportunity to cure most people with chronic hepatitis C, regardless of prior treatment failures. It is now possible to consider elimination of hepatitis C; the remaining barriers are the cost of therapy and access to care.

Keywords

Hepatitis C Retreatment Directly acting antivirals Chronic 

Notes

Compliance with Ethical Standards

Conflict of Interest

Maria A. Corcorran declares no conflicts of interest.

John D. Scott reports personal fees from Novartis, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleUSA
  2. 2.Harborview Medical CenterSeattleUSA

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